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Developing effective and equitable global health systems




A trio of leading health experts gave their views on how to create long-term, sustainable healthcare systems in the latest in the Oxford Martin School’s Now for the Long Term seminar series.

Professor Adrian Hill and Professor Andrew Pollard, Co-Directors of the Oxford Martin Programme on Vaccines, were joined by Professor Paul Klenerman, Principal Investigator at the Institute for Emerging Infections, and chair Professor Ian Goldin, Director of the Oxford Martin School.

Professor Hill said Now for the Long Term, the report of the Oxford Martin Commission for Future Generations, had highlighted “right at the front” the inequity in healthcare provision worldwide, and explained that while the largest number of malaria and TB infections were in Africa and south-east Asia, these were the areas with the lowest concentration of doctors and spending on scientific research. “It is often said that not enough spending goes into diseases of poverty, and too much goes into diseases of rich people," he said.

He said major threats to global health included antibiotic resistance, the possibility of a new flu pandemic, and the difficulty of large scale manufacturing and distribution of vaccines. Antibiotic resistance was not new, he explained, but had accelerated so that it was now at crisis point.

The solution, he said, lay in planning as well as medical advances: “We need to look ahead, and that’s where reports of this type are so important. Research takes time, it takes decades.

"For politicians it’s a challenge to prioritise things that matter for the next 50 years rather than next month. Look at antibiotic resistance:  a lot of it is about persuading the pharmaceutical industry to go back and think about making new antibiotics. How are we going to persuade pharmaceutical companies to invest in new drugs for a large population who can’t pay? We need more public sector investment.”

Professor Pollard said although child health could be transformed thanks to immunisation, access to vaccines was a major issue. “Access to current vaccines remains a problem, as does the deployment of newer vaccines and the development of new ones.” Another risk, he explained, was that of virus mutations coming together to form new viruses and cause a pandemic. “The H7N9 flu virus isn’t far off that. It’s a very real risk which is out there.”

Professor Klenerman said the possibility of curing Hepatitis C through drug therapy was on the horizon and a vaccine might be developed, but that investment in eradicating the disease would take huge investment and was “relatively low down the list of priorities” in some developing countries.

Looking at the incentives for companies to develop new drugs, he said: “It’s fantastically inefficient to make new therapies. The first steps are very wasteful. If the process could be made more efficient the cost would change enormously.”

Professor Goldin argued that although the future was unpredictable, major long-term decisions had to be taken. “The more we invest the more we can determine the future. We don’t know what’s going to happen but we know we can make it less challenging. Being paralysed in the face of uncertainty is absolutely the wrong way to go because we undermine any ability to embrace the future.”

Professor Klenerman added: “What we need is the risky investment, and that’s more difficult in an environment that’s increasingly regulated.”